Dziedzic Michał, Cackowski Marcin, Pawlica Maciej, Gabrysz Zuzanna, Gofron Krzysztof, Marjański Tomasz
Faculty of Medicine, Medical University of Gdańsk, Gdańsk, Poland.
Department of Thoracic Surgery, National Research Institute of Chest Diseases, Warsaw, Poland.
Transl Lung Cancer Res. 2024 Dec 31;13(12):3731-3740. doi: 10.21037/tlcr-24-446. Epub 2024 Dec 27.
Pulmonary carcinoids (PCs) represent a rare subset of neuroendocrine tumors (NETs) within the respiratory tract that exhibit unique characteristics and clinical behaviors. These tumors are currently staged according to the tumor-nodules-metastases (TNM) classification of non-small cell lung cancer (NSCLC), which brings their reliability into question. The aim of this study was to assess reliability of the current TNM staging of PCs and explore other relevant prognostic factors of patient outcomes.
From January 2023 to October 2023, the PubMed and Embase databases were searched according to predefined keywords. Studies focusing on PCs, TNM classification, surgical management, and lymph node involvement were included. The search included meta-analyses, retrospective studies, and case reports. Pediatric cases and articles written in languages other than English were excluded.
This review identified several retrospective cohort studies investigating the correlation between TNM staging, lymph node involvement, and survival outcomes in PC patients. Inconsistencies in survival rates across TNM stages were observed, highlighting the limitations of the current TNM classification as a main predictor of patient outcomes. Lymph node involvement emerged as a significant predictor of survival, with higher nodal stages associated with a poorer prognosis, especially for patients with atypical carcinoid tumors.
Excluding PCs from TNM staging of NSCLC and implementing new staging methods based on histological subtype and lymph node involvement may provide a better classification of this type of tumor, which could lead to more effective care for patients in the future.
肺类癌（PCs）是呼吸道神经内分泌肿瘤（NETs）中罕见的一个亚组，具有独特的特征和临床行为。目前这些肿瘤根据非小细胞肺癌（NSCLC）的肿瘤-结节-转移（TNM）分类进行分期，这使其可靠性受到质疑。本研究的目的是评估PCs当前TNM分期的可靠性，并探索患者预后的其他相关预测因素。
2023年1月至2023年10月，根据预定义关键词检索PubMed和Embase数据库。纳入关注PCs、TNM分类、手术管理和淋巴结受累情况的研究。检索包括荟萃分析、回顾性研究和病例报告。排除儿科病例和非英文撰写的文章。
本综述确定了几项回顾性队列研究，调查PC患者TNM分期、淋巴结受累与生存结果之间的相关性。观察到TNM各阶段生存率存在不一致，凸显了当前TNM分类作为患者预后主要预测指标的局限性。淋巴结受累是生存的重要预测指标，淋巴结分期越高，预后越差，尤其是对于非典型类癌肿瘤患者。
将PCs排除在NSCLC的TNM分期之外，并基于组织学亚型和淋巴结受累情况实施新的分期方法，可能会对这类肿瘤进行更好的分类，这可能会在未来为患者提供更有效的治疗。
